BEUDAMED
    FDA Adverse Event Malfunction Summary report: N

    REFLECTOR LIGHT

    MDR report key: 99203 · Received June 16, 1997

    Report

    Report Number
    2018492-1997-00003
    Event Type
    Malfunction
    Date Received
    June 16, 1997
    Date of Event
    May 14, 1997
    Report Date
    May 14, 1997
    Manufacturer
    BURTON MEDICAL PRODUCTS CORP.
    Product Code
    FSY
    Product Problem
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    IL, US
    Reporter Occupation
    OTHER

    Narratives

    Description of Event or Problem · 1

    THE LIGHTHEAD SEPERATED FROM THE SWIVEL.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 REFLECTOR LIGHT EXAMINATION LIGHT FSY BURTON MEDICAL PRODUCTS CORP. 0112022 12 95 BURT

    Patients

    Seq Age Sex Outcome Treatment
    1 NA